NPI | 1740783208 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0102205839) |
Enumeration Date | 2018-03-12 |
Last Update Date | 2023-06-14 |